Child mortality after high-titre measles vaccines: prospective study in Senegal

• Published in: The Lancet (British edition) Vol. 338; no. 8772; pp. 903 - 907
• Main Authors: Garenne, M., Leroy, O., Beau, J.-P., Sene, I.
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 12.10.1991; Lancet; Elsevier Limited
• Subjects: Biological and medical sciences; Cause of Death; Child mortality; Children; Children & youth; Confidence intervals; Death; Demographics; Developed countries; Female; Human viral diseases; Humans; Immunization; Immunization Schedule; Infant; Infectious diseases; Life Tables; Long-term effects; Male; Measles; Measles - mortality; Measles - prevention & control; Measles Vaccine - administration & dosage; Medical research; Medical sciences; Mortality; Multivariate Analysis; Population; Prospective Studies; Regression Analysis; Rural areas; Senegal - epidemiology; Survival Rate; Tropical medicine; Vaccines; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Senegal; Africa; Human; Infection; Skin disease; Viral disease; Mortality; Measles; Vaccination; Infant; Prospective Studies; Viral Diseases; Biology; Research Methodology; Child Mortality; Vaccines > administraction and dosage; Rural Population; Population Characteristics; Population; Vaccines > complications; Demographic Factors; Risk Factors; Africa; Seasonal Variation; French Speaking Africa; Causes Of Death; Diseases; Studies; Western Africa; Senegal; Data Analysis; Developing Countries; Africa South Of The Sahara; Population Dynamics
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/0140-6736(91)91771-L

The use of Edmonston-Zagreb high-titre (EZ-HT) vaccine at age 6 months has been recommended for countries in which measles before the age of 9 months is a substantial cause of death, but little is known about the long-term effects of high-titre live measles vaccines given early in life. In a randomised vaccine trial in a rural area of Senegal, children were randomly assigned at birth to three vaccine groups: EZ-HT at 5 months (n=336); Schwarz high-titre (SW-HT) at 5 months (n=321); and placebo at 5 months followed by standard low-titre Schwarz vaccine at 10 months (standard: n=358). All children were prospectively followed for 24-39 months in a well-established demographic surveillance system. Child mortality after immunisation was significantly higher in the two groups which received high-titre vaccines than in the group given the standard vaccine. The relative risk of death was 1·80 (95% confidence interval [CI] 1·18-2·74; p=0·007) in the EZ-HT group and 1·51 (0·97-2·34; p=0·07) in the SW-HT group compared with the standard group. The three vaccine groups were comparable as regards various social, family, and health characteristics, and there was no difference in mortality between children who received the standard vaccine and those who were eligible for the trial but did not take part for various reasons. The higher risk of death in the two high-titre vaccine groups remained significant in multivariate analyses. These findings suggest a need to reconsider the use of high-titre measles vaccines early in life in less developed countries.